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pate if 30 percent of their patient vol- ume is attributed to “needy” individuals who qualify for sliding-scale or free care, or for the Children’s Health Insurance Program.


The incentive payment is a fixed amount for each year of participation. Eligible physicians with at least 30-per- cent Medicaid volume could receive up to $63,750 over six years.


Eligible pediatricians with at least


20-percent Medicaid volume could re- ceive up to $42,500 over six years. Medicaid incentives roll out over six years instead of five as in the Medicare program. Medicaid pays out until 2021, so physicians could start in 2016 and still receive the full incentive. Also, phy- sicians can skip years. One warning to those whose participation is lagging: Should Congress repeal the EHR incen- tive funding, physicians waiting too long may miss out on some of the incentives. For Medicaid, physicians do not need to meet meaningful use in their first year. They simply must have a certified EHR. Year two of the program requires 90 days of meaningful use, and years three through six require demonstrat- ing meaningful use for the full calendar year (except, as noted above, in 2014, everyone will be required to demon- strate meaningful use for only 90 days). No penalties are associated with the Medicaid program. When registering for Medicaid, phy- sicians who plan to participate in the Medicaid EHR incentive program must first register on the CMS website at www.cms.gov/ehrincentiveprograms. CMS will alert Texas Medicaid, which will email the physician instructions on how to register for the Texas Medicaid EHR incentive program. PECOS enroll- ment is not required for the Medicaid program. Physicians must attest every year of participation.


Attestation. Physicians attest to meet- ing meaningful use on the CMS website at www.cms.gov/ehrincentiveprograms. All technical questions about registra- tion and attestation pages may be di- rected to the EHR Information Center by telephone at (888) 734-6433.


Stages of meaningful use Meaningful use is being rolled out in three stages:


• Years 2011 through 2013 constitute Stage 1. This is the data-capture and sharing stage.


• The second stage demonstrates advanced clinical processes. Stage 2 began on Jan. 1, 2014.


• The Stage 3 rules are not yet re- leased but are expected in late 2014 or early 2015. Stage 3 is meant to focus on improved outcomes in patient care.


Starting in 2014, all physicians must use an EHR certified for Stage 2, even if they are participating in Stage 1. Be- cause every physician EHR user in the country must upgrade in 2014, CMS is allowing 90 days of meaningful use for 2014. Everyone gets two years of Stage 1, with the exception of those who start- ed in 2011, before having to move to Stage 2.


Meaningful use goals


Each of the meaningful use criteria falls under one of these five goals:


1. Improve quality, safety, and efficiency, and reduce health disparities;


2. Engage patients and family; 3. Improve care coordination; 4. Improve population and public health; or


5. Ensure adequate privacy and secu- rity protections for personal health information.


Stage 1 meaningful use criteria All physicians must meet a core set of 14 meaningful use measures. A 15th measure is no longer required for physi- cians reporting in 2013 and beyond for Stage 1. Additionally, there is a menu set of 10 measures. Physicians must choose five from the set of 10, and one of them must be one of the two public health measures.


Exclusions. Thirteen of the now 24 meaningful use criteria allow “exclu- sions” for physicians to report that the


Quality and safety benefits of EHRs


EHRs enable health monitoring in re- gard to quality and safety. They provide drug alerts and recommended preven- tive services and immunizations, and allow physicians to track and trend a pa- tient’s blood pressure and body mass in- dex. Physicians can run reports on their patients who have specific conditions or need follow-up care or preventive ser- vices. Extracting this type of data is not feasible with paper records.


Quality-improvement measures.These meaningful use criteria are designated as quality-improvement measures:


• From the core set: • Computerized physician order entry (CPOE),


• Drug alerts, • E-prescribing, • Demographics, • Problem list of active diagnoses, • Medication list, • Medication allergy list,


February 2014 TEXAS MEDICINE 51


objective or measure is not applicable. For example, a physician who writes fewer than 100 prescriptions during the EHR reporting period is excluded from reporting on the drug formulary checks. For a list of the meaningful use


measures and details about each, go to www.cms.gov/EHRIncentivePrograms/ Downloads/EP-MU-TOC.pdf.


Product certification. Physicians must use “certified” EHR technology, i.e., the current product and version number must be certified for meaningful use. A product certification number is required for attestation. A product list is available at http:// oncchpl.force.com/ehrcert?q=chpl. Meaningful use products are either “complete” or “modular.” Modular prod- ucts require additional technology. For example, the EHR may not have an e- prescribing component, precluding a complete certification. The physician would have to install an add-on e-pre- scribing product to meet certification requirements.


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